The Unlonely Project: Art as a Path to Connection

Jeremy Nobel
Speaker 2 (00:02.606)
Hi everybody, this is Robin Strongin with Health Dame and this afternoon I have the absolute pleasure of speaking to my friend and colleague, Dr. Jeremy Nobel. And we've had the opportunity to share our love of the arts and music and how we see it intersecting with better health and innovation and all of the above. And rather than me take up all the time talking, Jeremy.

I am gonna start by asking you to introduce yourself, kind of the highlights. You wear a lot of hats, you're a physician, but tell us a little bit about yourself and your background so we set the stage here.

Well, thanks, Robin. First, it's a pleasure to be here. I feel honored to have a chance to work with you on this and really kind of share some of what's going on out there in the community. I'm Jeremy Nobel, as you mentioned. I am an internal medicine physician, also a public health practitioner, and also a poet and a creative maker. And I lead a nonprofit foundation, the Foundation for Art and Healing, which turns 21 years old this year.

Saw that I was looking, yes, 2003, right?

Exactly. 2004. Where was the time going? It was a fantastic ride we've been on. And they also feel very privileged to have an academic base. I've been on both the medical school faculty and the Harvard School of Public Health faculty in various roles for over four decades now.

Speaker 2 (01:44.715)
I get it. Yep.

There's much there that's inspiring these days too, despite the challenges.

Yes, yes, for sure. The foundation for art and healing, what was the impetus? Why that foundation? What got you there?

Well, let's work backwards from the mission. So the mission is to explore, promote, and facilitate creative expression as a path to health and well-being for individuals and communities. And it actually arose out of a personal experience I had with 9-11. I was really...

quite overwhelmed by that event on a variety of levels. You know, what's going on in the world, what's going on in me. And I turned to creative work to try to make sense of it. You know, and I was fortunate to have access personally to poetry, to visual image making, because I've just been enamored by it, although not a professional by any means since a teenager. And I realized

Speaker 1 (02:50.006)
I wasn't the only one in my conversations with friends. Many of them were turning to the arts just as a way to express themselves, not because they wanted to start art careers. But then it sensitized me to how powerful the arts were even for people who weren't artists. And that's what eventually led to the formation of the foundation.

I'm

Speaker 2 (03:12.064)
I love that. love that. And at the time of 9-11, remind me, were you already living in New York? I know you go back and forth between Cambridge and New York. During 9-11, where were you actually? just...

Ironically, I was at Stanford University. Oh, I was living in Boston at the time and I still do. Boston has been home since I came up to train at one of the Harvard teaching hospitals in 1981. Time to be part of the AIDS crisis. That's a whole other story we can talk about and what the arts have done for many people struggling with those situations.

Okay.

Speaker 1 (03:51.68)
But I happened to be at a two-day conference at Stanford on the future of digital technologies to healthcare. was ironic. There was a guy doing the first day leading all of that guy who is just terrific physician policy guy. His name's Alan Garber. He's been in the news. Alan's the president of Harvard University.

You

Speaker 2 (04:17.89)
Yeah, yeah, yeah.

And I had the second day where I had a whole portfolio of digital health companies that were going to talk about what they did. by 9 a.m. Eastern time, 6 a.m. Pacific time, we knew that September 11th was not going to be the day we planned, but we still were able to get the conference up and running. As part of the challenge, though, it took me at least 10 days to get back home. Everything was.

down.

Yeah. So that really kind of what's got me started with 9-11 and just seeing the complexity of it, the emotional tumult for people, the grief, the anger, the sorrow, and also just trying to make sense of the world.

That's what I was, yeah, for sure. It just didn't make sense at all. just couldn't, you didn't know what to do with yourself. You had all these feelings and you're, you know, it was frightening. I mean, so, so part of the work and the mission of the foundation has to do with loneliness. And people do, I know you do a really nice job of explaining, you know, the difference between being alone, being lonely, loneliness.

Speaker 2 (05:29.55)
social isolation and how that affects your health. know there have been some provocative statistics about, you know, the equivalence to smoking 15, I think it's 15 cigarettes if my memory serves me, I'm not quite sure. But what do we need to know about the difference because people get lonely during their life. What is it that you are looking at through? And then I want to know about the Unlonely Project. I know.

So our work on loneliness at the foundation really did emerge of all in an interesting way out of our work on trauma. Okay. And we saw how effective the arts were for kids in the five boroughs who were experiencing trauma in part because of the media coverage of 9-11 had those film clips we've all seen of the planes going into buildings.

over and over and over again

Over and over again. Adults filter that out, kids don't. So a large number of these young folks were having acute traumatic stress reactions, which included emotional liability, sleep disturbances, and an inability to focus in class.

And very simple art therapy techniques, draw what's on your mind and let's talk about it, turned out to be very successful. I found out about it because there was an exhibit in the museum of the city of New York during the summer after 9-11. And what I was first impressed by when I saw the exhibit was how compelling the artwork was. It wasn't professional work. was primitive, it was called primitive style, but it really got to me. And I called some of the folks, many of them from NYU,

Speaker 1 (07:06.48)
Child Life and the Psychology Department, I said, could you tell me more about what happened? They said, well, first of all, it was an incredible experience to work with these kids. And I said, did you notice anything unusual? And they said, well, the kids got better across race and class. So you didn't have to modify the therapeutic intervention technique for culture. You just asked them to draw what was on their mind. They brought all their culture to them.

cool. Yeah.

And so I heard that story and I'm not a neuroscientist, but I kind of had a working knowledge of it. I said something's going on in the brain that across culture gives people a way to make sense of their world and reduce the stress and the discomfort and the despair of a traumatic experience through a combination of making and sharing.

Did did do you know did the children I assume they're younger children were they in a room together drawing or did they draw and there do you happen to know I'm just wondering.

The majority of it were individual exercises. Yeah, they were, think, you know, eight years old and up. can still find the images online. They're still as powerful.

Speaker 2 (08:12.43)
Okay,

Speaker 2 (08:26.893)
Yeah

I'm out when they were made and that's what led me to have some confidence to use the arts as our first traumatic intervention 2004 5 and 6 a lot of active duty service members coming back from Iraq and Afghanistan with traumatic brain injury and PTSD combined.

We were able to collaborate with Walter Reed and with the Veterans Administration and very quickly saw that these very simple art making exercises had a role in the armamentarium of treatment for post-traumatic stress.

The big leap forward was recognizing that many things are stressful that go beyond the usual things like combat, domestic violence, having your home destroyed by a storm. And as we started looking at other stress like aging, you have the trauma of losing capabilities, vision, hearing, I know you're very familiar with this, cognitive capabilities, friends.

Very traumatic. Chronic illness is traumatic, especially if you're in a marginalized group already because of race or low income. And so as we started expanding into other types of trauma, we got a strong signal coming back in our research that these same art activities that were making people feel less stressed out also made them feel less lonely and more connected. We weren't looking for that finding.

Speaker 1 (09:56.238)
came out of nowhere and it really got our attention and that's what led to, you know, really reaching out to experts in the field, including Julianne Holt-Lundstedt, who's the one who came up with the 15 cigarettes, the research behind the 15 cigarettes a day quote, a fellow remarkable researcher named John Cacioppo at the University of Chicago, who very tragically died early of cancer. He had such insight into loneliness and how the brain worked

to alter behavior, to alter, obviously, physiology. So that's how we got started on loneliness.

If I'm remembering on for just as a point of reference, when you talk about the arts, it is certainly the drawing you've mentioned, but it's so much more than that. And also because am I remembering correctly, there was, I want to say a Marine, a big Marine who did something with masks.

maybe masks and that was really effective for him. He wasn't that interested in drawing. What was the story with the mask? It really got my attention, it really drew me in.

You know, the mask coloring is so effective in trauma. It's a very simple exercise in a way. give someone with trauma a paper mache mask and it's got a porous surface and so on. say, all right, so here's the exercise. On the front part of the mask, draw how you think people see you. On the inside part of the mask, draw how you see yourself.

Speaker 1 (11:32.822)
You know, people come up with these incredibly evocative images and then they talk about it and it gives them a sense as they do it in a group supportive situation, which is how we often do these kinds of activities, that they're not alone. Right. Right. That they have their specific interpretation of things because they're narrative is different.

specific

But the sharing and the realizing that you're connected to other people, to a bigger human story is tremendously effective at relieving distress. And so that's kind of how we started going down that road.

And the breadth of what you've been able to do, and then that led to the film festival, no? The Unlonely Film Festival and Project Unlonely. I think, are you in the ninth season? Is that possible that you're this?

memory. Yes, we are in the ninth season. so we, yes, we first got started with, these workshops that used very kind of deeply research based modalities, three that most people in the field of mental health will recognize. So, you know, first mindfulness, right?

Speaker 1 (12:53.142)
research base on mindfulness to put people kind of to calm down their their brains and have them be there. The second is creative making and the third is social learning.

And there's lot of research on the power of all three of those modalities. To the extent we had something to add, it's the unique combination, the integration of that into a relatively easy to deliver workshop. Because we have a public health model. We do deliver these workshops, but that's really our R &D activity. Once we have them refined, we actually build toolkits that allow a wide variety of community-based organizations to replicate them very quickly.

high degrees of impact into a very diverse group. So these are schools, libraries, museums, faith-based organizations, sometimes even healthcare delivers.

Imagine that. say a little bit about the work that you're doing with universities now talk about stress going on at the universities across the board. What what I know the work has really taken off there hasn't it in the last couple of years you've you've really put a lot of effort and research behind. Yeah, we do.

all this through a program we call Campus Unlonely. Let you a little bit of the background. First, to answer a very good question from earlier than it. So being lonely is not the same as being alone. Being alone is the state of isolation. Objectively, you can count the number of human contacts you have, the quality of those contacts. Loneliness is subjective.

Speaker 1 (14:35.552)
It's the feeling you have of the gap between the social connections you want to have and what you feel you experience.

Then who's lonely these days? You look around the world. Well, the Gallup organization did a very important global study they published two years ago in October. We're just coming up on the anniversary. Okay. To show something that often surprises people that the loneliest adult demographic is not older adults. It's the 18 to 28 year old crowd worldwide. Oh God. So it was recognized by some studies done by Cigna in 2018.

2019. That's what got our attention. But whatever's going on, the U.S. is exporting this globally. So for a variety of reasons, we thought it was urgent to really bring some tested solutions to campuses across the country. So the workshops, very simple models, are now active in 70 campuses.

my god that

They were used for, they were required for orientation in many campuses just this fall already. the Harvard Chan School of Public Health, University of New England, wonderful partners for many years. And it gives students a way to feel they have agency in finding and sharing their story.

Speaker 1 (16:04.716)
You give them simple prompts, they draw, they convert feelings. Like imagine the year ahead, right? That's what we do for orientation. How do you feel? Convert those feelings to color and put the color on a page.

And you said this is required or this is.

It was required this last fall for all incoming students at the University of New England, which is in Maine and at the Harvard Chan School of Public Health and a few others.

What did the students have to say after? What kind of feedback did you get from them?

they loved it because it gave them so much of orientation. First of all, everyone has this mix and orientation of anxiety and excitement and energy. sure. Right. So it's incredible, the energy. And I went as an observer. They were delivered by students and staff from these organizations. They don't deliver it. They did. They own it and deliver it.

Speaker 1 (17:00.182)
It was the only activity on their very kind of crammed orientation schedule that wasn't about getting something right or learning something critical to their success, like how to get an email, how to register for classes and which classes to pick. And they loved it.

And in fact, we got several emails and the schools got emails afterwards saying, we'd like to start a creative expression club. We want to be able to do this continually. There's such pressure on students. There's so much content. There's so much on how do I get good grades? How do I prepare for the next thing to just be with each other and share stories? It was like,

And you were sharing with me not so long ago that the suicide rate among young people is terribly catastrophically out of control, really too high. mean, right?

In the last 10 years, it's gone up 30 to 40 percent in that demographic. In addition to other worrisome statistics, we now know through some very good studies done by the CDC. Remember the CDC, very important organization. I hope it survives the mess we're in. That 60 percent, 60 percent of young women are persistently sad and hopeless, young teenage women. 60. So three out of five.

next video.

Speaker 1 (18:25.878)
And then they, and a lot of it is because of social media pressure to perform and compare.

Women are sensitive to that in their social networking with each other, a lot of body image dysmorphia, lot of eating disorders as a result, and lot of anxiety and depression. And so it's not a surprise. The question is, what can we do about it? And a very simple thing is to give people safe experiences, these young people safe experiences, to share their stories with each other. Right.

in a non-performative way where they feel safe, seen and heard.

So if people watching this want to get more information about the toolkits, about the programs, about the foundation, about the film festival, where should we direct them to? Give me some websites.

Yeah, come to artandhealing.org to spell it out for all.

Speaker 2 (19:21.346)
Yeah, and we

Within that you can find Project Unlonely. Got it. That's the best place. I'd be happy if you know I can share my email directly for people. I'm happy to email directly with people who are in.

You have a too that you've recently had published and tell me a little bit about the book.

So as our work was really starting to gain momentum around 2016, 17, several folks reached out and said, oh, there's a book here. You have to write a book. And I said, come on, I got a lot going on. I'm not writing a book. But it became obvious that there was an interest in the topic. This was all before the pandemic. And I signed the...

The agreement with Penguin Random House to publish this book in January 2020.

Speaker 2 (20:15.606)
Yeah, timing is everything, right?

Go back to 9-11, it's as if you had signed an agreement to write a book on world terrorism two months before the World Trade Center. Everything changed. Writing that book, I think, has been one of the most important experiences of my life. made me...

Right.

Speaker 1 (20:33.48)
I confront my own loneliness, which I was not expecting I would need to do. Otherwise, you know, I thought, I'm to write a science journalism book with a few anecdotes and, you know, some, you know, kind of simplified science. What I ended up doing, and I'm so glad I did, was adding a little bit of my own personal story to the book.

I nothing like a personal story. earlier this week, or the end of last week, interviewed Dr. Rachel Brehm, who's a radiologist and runs the Breast Imaging Center at GW. And she also wrote a book about her personal experience with breast cancer, her mom herself, her daughters, and so on and so forth. There's nothing like personalizing

A story, especially when you're an expert in a field and people people are hungry to look for experts whom they trust and that they want to know that they understand and it makes it makes such a difference. makes such a difference. Tell us the title of your book. So if anybody

It's called Project Unlonely, which is our project to use the arts to engage, inspire, activate, and connect. Project Unlonely, healing our crisis of disconnection.

Wow. And while I do draw on information from Project Unlonely as part of telling the story, it's really, I did it to demystify and humanize loneliness so people could design their own project on lonelies. And it's been out for about 18 months now and I'm getting tremendous feedback from people who basically thanked me for the book. had no idea how fulfilling that would feel.

Speaker 2 (22:22.487)
Yeah.

Speaker 2 (22:25.858)
Because you offer practical information. I mean, there's something people can do to start to feel better. And that is such a gift because it's, and you don't have to travel far. You give exercises right in the home. It doesn't have to cost a lot of money. You don't need a prescription. don't need, you know, it's, can do, and it, as I said earlier, it isn't, it isn't only drawing. I know you've talked about the arts.

The big thing about creative arts is to recognize that... All of beautiful... The traditional four are visual arts, movement arts, language arts like my art, poetry, and music.

It's hardening.

Speaker 1 (23:09.238)
I know you're a great lover of music. I am too. We'll talk more about that if you like. But what really people do on their daily creative journey, much more commonly, are culinary arts where you have taste, aroma, color, right? And you get to design all of that. Textile arts, which have been around since the beginning of society, really. Knitting, sewing, crocheting, quilting.

Many a revolution was planned around a quilting circle and Madame Defarge and whatnot.

And you probably have heard how effective it was, like the AIDS quilt. There's also a diabetes quilt, you know, where people can express personal activity, personal feelings. And then when they put their little square with all the other squares, which is what we do in our workshops, they realize they're part of a bigger story.

100.

Speaker 2 (24:02.934)
That is so key. That is just, I've seen it in action and it just made, and when you're, you know, even doing it individually, but then seeing how it can connect. And when you're in a room, because I did have the good fortune to be with you for one of the programs down in, was it Georgia, Jeremy? Augusta, Georgia with some senior citizens and-

That's right, we went to Augusta, Georgia.

Speaker 1 (24:28.18)
It was family caregivers as I recall. Wow, good memory. That was a while ago.

It was a long time ago, but it stuck with me because people who didn't necessarily know one another, but they had the shared challenge in their life of caregiving in all its texture and dimensions. they had an opportunity to not just unburden themselves, so to say, but they were doing something fun and they were socializing. suddenly, and I remember you explaining in the beginning that

There is peer-reviewed literature about how your brain chemistry changes when you are connected and when you're expressing. It's healthy for you. It's a good thing to do. It's not just fun.

The other great thing is the brain studies have really advanced and we're learning a lot more about art and brain. Susan Meg Salmon, who's at the Johns Hopkins Arts and Brain Institute, probably a good person for you to get to know. Put a book out about two years ago, New York Times bestseller called Your Brain on Art.

I have heard that title. Okay. I just remember the name. Okay.

Speaker 1 (25:42.207)
And we're very...

you know, engaged in some of the neuroscience of art and brain. One of the most interesting things, and I do write about it in my book, first of all, it's based on some really important knowledge that when you make art and have these conversations, the levels of the stress hormone cortisol go down. And the feel-good hormones, oxytocin, dopamine, serotonin go up. So you're less stressed, you're in a good mood. That's a great way to connect with people, but wait, there's more. It turns out...

that your brain is always on alert, looking at the world around you to see whether it's an opportunity or a threat. Because the brain's job is survival. It turns out that as people get lonelier, we know through this amazing researcher I mentioned earlier, John Cacioppo, that they start seeing the world as more threatening.

And if you know lonely people, you know exactly what I'm talking about. And it's a spiral. They see the world is threatening, so they back away. Well, their brains get lonelier. Then the world's more threatening. What do they do? They back away more. At some point they change how they behave. They're pretty either nasty or sometimes they get pretty obnoxious.

Yeah, and they're just really related and that's what the spy. my

Speaker 1 (27:01.314)
So that's the spiral. What the arts do, and now there's good brain research to show it, is that creative arts actually excite the same parts of the brain that alter social cognition, which actually provides a neuroscience basis for empathy and compassion.

There you

And how the arts increase empathy and compassion. They're now good studies that even seeing films make you more empathic. No surprise, but it's nice to have the research.

Yeah, well nine seasons of showing your your film.

And we're really expanding the film reach because we think that these, and by the way, there are 150 of these films. They're all under 15 minutes. They all, all kinds, narratives, documentaries, animated films, and they all use the power of film to explore loneliness and the positives of connection, belonging.

Speaker 1 (28:02.222)
the incredible positive human energy that powers thriving and flourishing when you realize you're not alone. You're part of a bigger group. You're part of a human story. And our goal is to make those films available to hundreds of thousands of people. We're in the few hundred thousand range, but this is the year we're, and we're fortunate to have the support of Steve Buscemi.

like scaling up. Well, and you not only have these films available, but I know that you have interesting activities that are associated with them, questions to be asked, projects to do, prompts for writing something or drawing something or how you might engage with somebody else. So it really connects the dots for people who may be a little nervous about dipping their toe. You really send them a lifeline on how to

get involved in this as slowly or dive right in whatever is somebody's comfort.

think the big opportunity with the films, Robin, is now we're getting the attention of the same community organizations that have been running our workshops. Great. And they say, wait a minute, this can be like a way to prime the pump because many people, particularly men, if you say come make art together, maybe that's not something... If you ask people, hey, let's go watch a movie and then we're going to talk about it. every, no one's intimidated about going to...

That's why I'm saying this is impossible.

Speaker 2 (29:27.178)
Everyone loves to do.

Everyone in America feels they're an expert.

That there's no. For sure, and I know that you know sometimes people are lonely because they don't feel well or they have a condition that really limits their ability to engage comfortably, whether it's chronic or what have you. So I know that.

And they certainly have opinions.

Speaker 2 (29:55.563)
I don't really understand exactly, but I know the edge of medicine. Tell us a little bit about that how that relates.

So in my book, there's an entire chapter really focused on the loneliness of serious illness. Because what happens with serious illness is you start to see yourself differently. You see yourself as someone with a condition that others may then not be excited to have you around or it may make them uncomfortable. This is particularly true with cancer.

where people, it reminds them of their own mortality and so on. Now they're lovely people, they want to be helpful and so on, but they often say, oh, know, Robin must need some space, right? To deal with these challenging things. Then within all of these chronic illnesses, there are a subset that I'm very, very concerned about because

while we recognize them, long COVID is an example, chronic fatigue syndrome, now called myalgic encephalitis, and Lyme arthritis, chronic Lyme disease, all have these very unusual mixtures of symptoms that include things like brain fog and overwhelming weakness where you just can't get out of bed. And you go to the healthcare system and they don't have a lot to offer you.

so often patients feel, my gosh, know, now I've been abandoned by the healthcare system. Their employer, you know, at some point gets a little bit unsure about, okay, well, how long can we keep you on limited ability? And so these people become very, very isolated. Now here's the other thing to know, which is that chronic loneliness also increases inflammation and reduces immune function.

Speaker 1 (31:43.468)
We don't know a lot about these diseases, but we know they're inflammatory disorders and we know they're immune mediated. And so it's this terrible risk for a negative spiral. What do we do about it? Well, first increase awareness that loneliness doesn't have to be a comorbid condition of your chronic illness. And we have to take it seriously in the healthcare system and encourage people.

even with all the other things they have to do for their medical treatment, that social connection with others is a critical part of self-care.

Absolutely. I mean, I've seen this personally and it makes a world of difference as does music and music in the brain as we've talked about. being respectful of your time, I know we're getting to time here. My final question for you is, you know, one of the things that Brian and I did together before he passed really the whole time was every day I

put together a different playlist for him of music. And he was quite the connoisseur. so really to honor his legacy, I'm creating a health theme playlist. And everybody I have a conversation with, I always ask, do you have either a favorite song or a song that reflects the work?

that you're doing and I want to know what your song is that I can add to the health game playlist. And if you don't have one off the top of your head, you can certainly let me know. But if you do, can you share it?

Speaker 1 (33:23.758)
It'd be my pleasure. There's so many amazing songs.

It's hard to narrow it down, I know.

Right, you you got The Beatles, Eleanor Rigby and so on. The one that I am just intrigued with as we know there's a particular crisis of loneliness among men is by The Traveling Wilburys, a musical group that had Roy Orbison, George Harrison, Bob Dylan. I forget who else. there's an amazing song they have called Handle Me With Care.

And I'm gonna get emotional too. these are, know, men, pride ourselves on strength and, you know, we wanna be there, you know, for the people that we provide for, that we protect. But we're vulnerable too. And we don't know how to ask for it to be cared for and cared about. But this song just captures it brilliantly. And the lyrics are amazing.

Fabulous, could not be a better choice. That's amazing. So art and healing.org. We have a book to look up. We have a lot of activities and the ninth season of the film festival. And I want to end on a hopeful note. And that is just to say that the literature really, the research bears out that it's being creative, connecting socially.

Speaker 2 (34:52.585)
It's fun, it's good, it's healthy. And anything else, Jeremy, before we...

The thought I want to leave on an uplifting and really important note, if you're lonely and listening to this, I've got to tell you, it's not your fault. Loneliness is a biologic signal that's been with us since evolution. We need to be with other people. It's the way our bodies tell us we need that, just like thirst tells us we need hydration. So if you view loneliness that way, rather than the way many people do is that as if they're flawed, inadequate or something wrong, it completely changes.

how you can approach loneliness as an opportunity to thrive and flourish by doing what your body, mind, dare I say it, your soul guides you to do, which is to continue.

I meant to that, yeah. No, all of the above. I think that's really important because we, know, myself included, but what's wrong with me? And in fact, there are good scientific explanations for what's going on. It's not bad. It's just what's going on. And the nice thing, the really great thing is there are things you can do to fix it and they're very doable. So Jeremy, it's always incredible.

incredibly fun to talk to you and the work is so important and I'm looking forward to the 10th season and all the great things that I know you and the team at the foundation are going to continue to do. It's really been something watching it just explode and take off and people understanding how important what you're doing is and I guess we saw it through 9-11, we saw it through COVID.

Speaker 2 (36:31.488)
and just day to day. And so thank you for the work that you're doing. And I'm really looking forward to follow up conversations, because as you know, I could talk forever. with that, I'm going to end today's session, but invite you back. And thank you, thank you. And I will be in touch. Thanks again, Jeremy. Take care now. Absolutely. care. Bye bye.

pleasure.